Lifestyle change, combination niacin and fenofibrate beneficial for patients with HIV

Balasubramanyam A. J Clin Endocrinol Metab. 2011;96:2236-2247.

Issue: September 2011

Treatment with niacin and fenofibrate, besides regular exercise and a diet low in saturated fat, improved HDL and triglyceride levels in patients with HIV receiving antiretroviral therapy, according to data from the Heart Positive trial.

Elevated triglycerides, low HDL and hypoadiponectinemia are common dyslipidemic characteristics among patients with HIV taking antiretroviral therapy (ART). However, adverse interactions between ART and certain statins, as well as a high prevalence of hepatitis C in this population, hinder the efficacy of lipid-lowering agents.

The randomized controlled, double blind, 24-week trial included 191 patients (46% Hispanic, 36% white, 17% black) with HIV who were taking ART. According to the new data, fenofibrate (Tricor, Abbott Laboratories) induced significant improvements in triglycerides (P=.002), non-HDL (P=.003) and total cholesterol (P=.02); niacin (Niaspan, Abbott Laboratories) boosted HDL levels (P=.03). Combining fenofibrate with niacin also considerably lowered the ratio of total cholesterol to HDL cholesterol (P=.005 to P=.01).

When added to a low saturated fat diet and an exercise program involving three weekly, supervised, 75- to 90-minute sessions conducted 3 days per week, combined niacin and fenofibrate use conferred optimal benefit, according to the researchers. Compared with a usual care group that received only general advice about diet and exercise, patients in the intervention group experienced a 52% decrease in triglycerides (P=.003), 12% increase in HDL (P<.001), 18% decline in non-HDL (P=.003) and 24.5% reduction in the ratio of total cholesterol to HDL (P,.001). The researchers also noted a doubling of adiponectin with niacin use.

“A rationally based, combinatorial approach using niacin and fenofibrate with low-saturated-fat diet and exercise is both effective and safe in improving the [cardiovascular disease] risk factors of low HDL, elevated non-HDL, and hypertriglyceridemia among HIV patients on [ART],” the researchers wrote. “Its effectiveness across different ethnic groups and [ART] regimes makes these results broadly applicable to dyslipidemic HIV patients, including ethnic minorities with increasing prevalence of HIV infection.”

Disclosure: One researcher reports receiving grant and research support, consultant fees and honoraria from Abbott Laboratories.

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